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免疫检查点抑制剂相关心肌炎的心脏磁共振成像

Cardiac Magnetic Resonance Imaging in Immune Checkpoint Inhibitor-Related Myocarditis.

作者信息

Hammer Matthew, Tysarowski Maciej, Fuss Cristina, Bader Anna S

机构信息

Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA.

Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.

出版信息

Echocardiography. 2025 Mar;42(3):e70131. doi: 10.1111/echo.70131.

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized oncologic treatment, offering a novel and effective approach to personalized cancer immunotherapy. By targeting immune tolerance pathways, ICIs enhance T-cell-mediated tumor cytotoxicity. Despite their therapeutic efficacy, ICIs are associated with immune-related adverse events (irAEs), including severe cardiovascular complications like myocarditis, pericarditis, and vasculitis. ICI-related myocarditis, although uncommon, carries a high mortality rate of up to 50%, particularly in patients receiving combination therapies. This review examines the mechanisms of ICIs, highlights the clinical presentation of cardiac irAEs, and underscores the utility of cardiac magnetic resonance imaging (CMR) in the diagnosis of ICI-associated myocarditis. Through case studies, we illustrate the diagnostic and therapeutic strategies for ICI-related cardiac complications, highlighting the importance of multidisciplinary collaboration in mitigating morbidity and mortality.

摘要

免疫检查点抑制剂(ICIs)彻底改变了肿瘤治疗方式,为个性化癌症免疫治疗提供了一种新颖且有效的方法。通过靶向免疫耐受途径,ICIs增强了T细胞介导的肿瘤细胞毒性。尽管ICIs具有治疗效果,但它们与免疫相关不良事件(irAEs)相关,包括严重的心血管并发症,如心肌炎、心包炎和血管炎。ICI相关的心肌炎虽然不常见,但死亡率高达50%,特别是在接受联合治疗的患者中。本综述探讨了ICIs的作用机制,强调了心脏irAEs的临床表现,并强调了心脏磁共振成像(CMR)在诊断ICI相关心肌炎中的实用性。通过案例研究,我们阐述了ICI相关心脏并发症的诊断和治疗策略,强调了多学科协作在降低发病率和死亡率方面的重要性。

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